Frailty Linked With Worse Outcomes, Functional Declines in Older Patients With NSCLC


Patients 65 years and older with NSCLC and undergoing treatment with immunotherapy, chemotherapy and/or targeted therapy were more likely to have worse survival outcomes and declines in activity of daily living.

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“Notably, frailty was not associated with age or treatment type,” the researchers wrote.

Frailty was linked with worse survival and a decline in activities of daily living in older adults with advanced non-small cell lung cancer (NSCLC) treated with chemotherapy, immunotherapy and/or targeted therapy, as demonstrated by recent study results.

“Identification of pretreatment frailty may help inform decision making, individualize anticipatory guidance and optimize supportive care,” the researchers wrote in the poster presented at the 2023 ASCO Annual Meeting.

Researchers analyzed data from 149 patients aged 65 years and older (median age, 73 years) with advanced NSCLC who started treatment with immunotherapy (29%), chemotherapy (12%) and/or targeted therapy (32%) with noncurative intent, meaning that it is focused on life-prolonging treatment and palliative care.

Patients completed assessments before starting treatment and at one, two, four and six months. Researchers integrated this information and others such as clinical factors to develop a scoring system. These scores were used to categorize patients based on their frailty status: robust (43%), pre-frail (38%) and frail (19%).

Researchers focused on several outcomes including overall survival (the length of time when a patient with cancer is still alive), treatment-related side effects considered severe or worse, functional decline in activities of daily living and unplanned hospitalization.

The findings demonstrated that patients considered frail were more likely to be Asian, have Medicaid insurance, lower education and did not previously undergo surgery for NSCLC.

“Notably, frailty was not associated with age or treatment type,” the researchers wrote.

For the overall study population, the median overall survival was 18.7 months. When broken down by frailty status, the median overall survival was not reached for patients who were considered robust. This means that more than half of patients in this group were alive when researchers were calculating this. The median overall survival was 8.9 months in those considered pre-frail and 5.6 months in patients considered to be frail.

When the type of treatment was taken out of the analysis, researchers determined that patients considered pre-frail and frail had worse overall survival compared with those considered robust.

While undergoing treatment, 29% of patients in the study experienced a side effect graded as severe or worse. In addition, 41% of patients experienced a decline in activities of daily living and 31% had an unplanned hospitalization.

Patients who were considered to be pre-frail or frail were more likely to develop a decline in activities of daily living compared with those who were robust. In contrast, the rates of hospitalization or side effects did not differ.

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Image of Dr. Minesh Mehta at ASCO 2024.